Lab games (pre exam 1) Flashcards
A pt has low hemoglobin, low hematocrit, and low MCV (<80fL). What are 4 important causes you have on your DDX?
TICS:
1) Thalassemias
2) Iron deficiency
3) Anemia of chronic disease/ inflammation
4) Sideroblastic anemia (lead)
What are the 2 most common causes of anemia worldwide?
1) Iron deficiency
2) Anemia of chronic disease/ inflammation
You are reviewing a pt’s CBC result and note they have a low hemoglobin and low hematocrit with a high MCV (>100fL).
What are the 2 most common causes of this pt’s lab values?
Vitamin B12 and folate deficiency are the 2 most common causes of a megaloblastic macrocytic anemia
What labs are important in evaluating hemolytic anemias? What would those lab values be?
1) Hgb/ Hct: Low
2) Retic count: usually high
3) Indirect bilirubin: high
4) LDH: high
5) Haptoglobin: low
6) Urinalysis: pt may have hemoglobinuria
7) Periph. smear: may have abnormal RBCs/ cells
8) Direct antiglobulin (Coombs) test (DAT): usually abnormal if immune causes (warm/cold autoantibodies)
9) Hemoglobin electrophoresis: may be abnormal in conditions like sickle cell disease, beta thalassemia, etc
A 25 y/o male presents w. periodic reddish-brown urine that he usually notices in the mornings. He said he’s had blood clots in the past.
What acquired hemolytic anemia are you concerned abt, and what is the underlying pathophys?
Paroxysmal nocturnal hemoglobinuria (PNH): rare acquired clonal hematopoietic stem cell disorder where the membrane is abnormally sensitive to lysis by complement
A 20 y/o African American man presents with yellowing of his skin and eyes, dark urine, fatigue, and palpitations over the past day. He recently took an anti-malarial.
What is the most likely Dx and what 4 labs would you order? What would these labs show if you’re correct?
G6PD deficiency:
1) CBC: anemia
2) Retic. count: elevated
3) CMP: elevated indirect bilirubin
4) Periph. smear: Heinz bodies and bite/blister cells
If you indirectly measure the G6PD enzyme activity level in a pt with G6PD deficiency during a symptomatic episode, what would you expect it to be?
May come back as falsely normal bc the pt is currently having acute hemolysis.
A 30 year old man presents with weakness, fatigue, and jaundice. He notes he was recently prescribe penicillin for strep throat. He otherwise has no known medical problems. On labs you note low Hgb/ Hct, high indirect bilirubin, high LDH, and low haptoglobin.
What Dx do you suspect? What is the primary Tx?
Drug-induced immune hemolytic anemia; stop offending drug (penicillin) and make sure he avoids it in the future
A 25 year old female presents with weakness/ fatigue and pallor. She notes she has had an abnormally high number of bacterial infections recently. You also note petechiae and purpura.
What lab findings would case these manifestations? What is your suspected Dx?
1) Anemia: pallor, weakness/ fatigue
2) Neutropenia: vulnerability to bacterial/ fungal infections
3) Thrombocytopenia: mucosal and skin bleeding (petechia/ purpura)
Aplastic anemia (causing pancytopenia)
A 20 y/o female presents with h/o menorrhagia and GERD and with current weakness/ fatigue. CBC + iron studies confirm microcytic anemia and iron deficiency.
How would you recommend repleting this pts iron deficiency? What instructions would you give this pt on how to take their med? What side effects should they know abt?
Ferrous sulfate 325mg PO Qday or QoD on an empty stomach. Taking w. vitamin C (orange juice) helps absorption. Avoid taking antacids. Nausea and constipation are common SEs
If a pt has iron deficiency anemia, how long should it take for Hct to return to normal?
2 months (halfway to normal after one month)
Which 2 conditions would you expect to see a prolonged PT time?
Vitamin K deficiency + DIC
True or false: Anemia of chronic disease is a part of the TICS mnemonic
True
True or false: Bleeding of the gums may be seen with aplastic anemia
True
Trimethoprim-sulfamethoxazole use may increase a patient’s risk for what?
Folate deficiency
True or false: pregnancy risk may increase risk of folate deficiency
True
If a patient stops eating, will they run out of B12 stores or folate stores more quickly?
Folate will be affected more quickly
List 3 Sx that may occur with thrombocytosis
1) Bleeding
2) Erythema and painful burning sensation to the hands (erythromelalgia)
3) Thrombosis
Name an X linked recessive disorder
G6PD
Howell-Jolly bodies + target cells on peripheral smear are a symptom of what?
Sickle cell anemia (Hyposplenism)
A 68-year-old male had routine labs done for his annual visit with his primary care provider. His labs revealed Hgb 9.0, MCV 120, WBC 3,500 with neutropenia, and PLT 80,000. A follow-up peripheral blood smear showed macro-ovalocytes. He was referred to hematology/oncology and is scheduled for a bone marrow aspiration and biopsy.
Based on the most likely diagnosis, what two events would be the most likely cause of death in this patient?
MDS; Infection or bleeding. MDS is fatal .
A 73-year-old African American male was recently diagnosed with plasma cell myeloma. Which one of the following labs/diagnostic findings characterizes a myeloma-defining event?
Findings:
* Calcium 7.8
* Creatinine 2.3
* Hgb 10.9
* Arthritic changes on x-rays
Creatinine 2.3
A 58-year-old male was diagnosed with leukemia. His only symptom at diagnosis was fatigue. He had pancytopenia and Auer rods on peripheral blood smear, and 35% blasts on bone marrow biopsy. What abnormality is most likely the cause of his fatigue?
Auer rods are strongly assoc with AML. The fatigue is likely due to the pancytopenia, specifically the anemia part.
Which of the following patients is most likely to develop a Hodgkin lymphoma?
a) 32-year-old male
b) 6-year-old female
c) 82-year-old male
d) 55-year-old male
c) 82-year-old male
(most common in 20s and 80s)
